Procedure for Ordering a Mammogram

The mammography requisition form can be found in the top drawer of the standing file cabinet in the provider room. A clinical breast exam does not need to be performed prior to sending the patient for mammography.

Diagnostic Mammograms

The mammography requisition form can be found in the top drawer of the standing file cabinet in the provider room. NOTE: This is different from the standard Radiology requisition. A clinical breast exam does not need to be
performed prior to sending the patient for mammography.

For diagnostic mammogram, please fax the mammogram requisition form (same form used to request screening) to: